Myocardial strain by 3D-speckle tracking echocardiography predicts long-term risk of cardiovascular morbidity and mortality in the general population: the Southall And Brent Revisited (SABRE) study
Myocardial strain by 3D-speckle tracking echocardiography predicts long-term risk of cardiovascular morbidity and mortality in the general population: the Southall And Brent Revisited (SABRE) study
复制标题
3D 斑点追踪超声心动图的心肌应变可预测一般人群心血管发病和死亡的长期风险：索撒尔和布伦特重访 (SABRE) 研究
DOI：
10.1093/eurheartj/ehab724.067
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发表时间：
2021
影响因子：
39.3
通讯作者：
Al Saikhan L
中科院分区：
文献类型：
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作者：
Al Saikhan L
背景二维超声心动图的左心室（LV）射血分数（EF）和整体纵向应变（GLS）均可预测死亡率和心脏事件，并且GLS可能上级于EF。三维斑点追踪超声心动图（3D-STE），最近验证的方法，允许同时评估EF，GLS和主切向应变（PTS），但其在一般人群的预后效用是unknown.PurposeWe假设，3D-STE衍生的LV心肌应变预测复合心脏终点，GLS将是一个更好的预后指标比EF。我们还调查了PTS与GLS和EF相比的效用。方法来自SABRE研究（一项基于英国的三种族社区队列）的总共529名个体（69± 6岁; 76.6%男性）接受了健康检查。使用考克斯比例风险模型（调整和不调整潜在混杂因素）确定3D-STE EF或多向心肌应变与复合心脏终点（包括冠心病（致死性/非致死性）、心力衰竭住院、新发心律失常）之间的相关性，并计算Harrell's C统计量。与心血管（CV）死亡率的相关性作为次要目的进行检查。3D-STE EF，GLS和PTS的增量值在改善CV风险分层的建立Fragrance风险评分（FRS）进行了研究，使用似然比检验一系列嵌套的考克斯比例风险models.ResultsDuring后续（中位数，8年），有56个复合心脏终点和24 CV死亡。EF和径向应变呈负相关，而GLS、整体周向应变和PTS与未调整模型中的复合心脏终点呈正相关（表1）。尽管估计值的置信区间略有增加，但调整潜在混杂因素后，相关性仅受到轻微影响（表1）。对于复合心脏终点，EF、GLS或PTS的C统计量几乎没有差异（表1）。与CV死亡率的相关性通常较弱，在未校正和校正模型中，仅GLS显示出与CV死亡率正相关的一些证据（表1）。与EF和GLS相比，PTS最能改善FRS对复合心脏终点的预测值（模型拟合）（表2）。没有令人信服的措施提高校准CV mortality. Conclusions 3D-STE衍生的LV心肌应变预测不良心脏事件和CV死亡率在英国一般人群的多种族样本。PTS/3D应变是心脏事件的独立预测因子，有证据表明它是比常规LV功能指标（GLS和EF）略好的预测因子。未来的前瞻性研究需要确认和扩展这些发现。主要资金来源：SABRE的主要研究得到了Wellcome Trust和BHF的支持。
BackgroundBoth left ventricular (LV) ejection fraction (EF) and Global Longitudinal Strain (GLS) by 2D-echocardiography predict mortality and cardiac events, and GLS may be superior to EF. 3D-speckle tracking echocardiography (3D-STE), a recently validated method, allows simultaneous assessment of EF, GLS and principal tangential strain (PTS), but its prognostic utility in the general population is unknown.PurposeWe hypothesized that 3D-STE derived LV myocardial strains predict a composite of cardiac endpoints, and that GLS would be a better prognostic marker than EF. We also investigated the utility of PTS compared with GLS and EF.MethodsA total of 529 individuals (69±6y; 76.6% male) from SABRE study, a UK-based tri-ethnic community cohort, underwent health examinations. The association between 3D-STE EF or multidirectional myocardial strains and a composite cardiac endpoints comprising coronary heart disease (fatal/non-fatal), heart failure hospitalization, new-onset arrhythmia was determined using Cox proportional hazards models with and without adjustment for potential confounders and Harrell's C statistics were calculated. Associations with cardiovascular (CV) mortality was examined as a secondary objective. The incremental value of 3D-STE EF, GLS and PTS in improving CV risk stratification by the established Framingham risk score (FRS) was investigated using a likelihood ratio test on a series of nested Cox proportional hazards models.ResultsDuring follow-up (median, 8y), there were 56 composite cardiac endpoints and 24 CV deaths. EF and radial strain were negatively associated, while GLS, global circumferential strain and PTS were positively associated with the composite cardiac endpoints in unadjusted models (Table 1). Associations were only marginally affected by adjustment for potential confounders although confidence intervals of the estimate increased slightly (Table 1). There was little difference in the C-statistics for EF, GLS or PTS for the composite cardiac endpoints (Table 1). Associations with CV mortality were generally weaker and only GLS showed some evidence of a positive association with CV mortality in unadjusted and adjusted models (Table 1). Compared to EF and GLS, PTS most improved the predictive value (model fit) of FRS for composite cardiac endpoints (Table 2). None of the measures convincingly improved calibration for CV mortality.Conclusions3D-STE-derived LV myocardial strains predicted adverse cardiac events and CV mortality in a multi-ethnic sample of the UK general population. PTS/3D-strain was an independent predictor of cardiac events with some evidence of it being a slightly better predictor than conventional indices of LV function (GLS and EF). Future prospective studies are needed to confirm and extend these findings.Funding AcknowledgementType of funding sources: Foundation. Main funding source(s): The main SABRE study is supported by the Wellcome Trust and BHF.